Heroes Not Zombies

It is part of the unifying disposition of the right hemisphere to see similarity within difference and part of its capacity for fine discrimination to see difference within similarity, whereas the isolating disposition of the left hemisphere sees similarity and difference as a simple opposition.

Iain McGilchrist. The Matter with Things

One year I visited my friends in Capetown and we went to the Saturday morning Farmers Market. I don’t think I’ve ever seen a bigger, more diverse, display of pumpkins. Aren’t they glorious?

This image is one which has stayed with me since then. It captures what Iain McGilchrist is referring to in this passage… the similarities in difference and the difference in similarity.

This was always a core issue for me as a doctor. With every single patient, at every single consultation, I had to understand what was familiar to me, what the similarities were between this patient and another, between this visit and the previous one. I’ve written many times about the importance of keeping a focus on uniqueness when it comes to making a good diagnosis, but the same thing applies to treatment. There’s a simplistic generalist form of thought which claims there are medicines which work and those which don’t, but you don’t have to work in general practice for long to realise that’s nonsense.

There’s only one way to find out the effects of particular treatment in a particular patient – follow up. I think this is why joined up practice based on continuity of care is so important. At follow up the doctor has to assess what’s familiar and what’s not…what’s similar and what’s different….by listening to the next chapter of the patient’s story. Only this unique person can tell you whether or not a particular treatment has benefited them.

I think the same principles apply in other areas of life. We meet new people, discover what we have in common, form connections on that basis and at the same time we are curious to discover each other’s differences, to find out what is unique in each other, and so to create another, unique relationship.

Similarities and differences aren’t in opposition to each other. They work together to create uniqueness.